Legislature(2017 - 2018)ADAMS ROOM 519

04/02/2018 01:30 PM FINANCE

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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
-- Delayed to 2:55 pm --
Heard & Held
-- Public Testimony --
Heard & Held
-- Public Testimony --
Moved HB 400 Out of Committee
-- Public Testimony --
+ Bills Previously Heard/Scheduled TELECONFERENCED
HOUSE BILL NO. 268                                                                                                            
     "An  Act   relating  to  the  prescription   of  opioids;                                                                  
     relating   to  the  Department   of  Health  and   Social                                                                  
     Services;   relating  to   the  practice  of   dentistry;                                                                  
     relating  to the practice  of medicine;  relating  to the                                                                  
     practice  of  podiatry;   relating  to  the  practice  of                                                                  
     osteopathy;  relating  to the  practice  of nursing;  and                                                                  
     relating to the practice of optometry."                                                                                    
3:01:13 PM                                                                                                                    
REPRESENTATIVE LES GARA, SPONSOR, introduced himself.                                                                           
CLAIRE   GROSS,   STAFF,   REPRESENTATIVE   GARA,   introduced                                                                  
Representative  Gara  explained  that the  difference  between                                                                  
the  proposed  Committee  substitute  (CS)  and  the  original                                                                  
bill was  the transfer  of requirements  that were  consistent                                                                  
with  the Center  for  Disease  Control (CDC)  guidelines  for                                                                  
informing  patients  about  the dangers  of  opioid  addiction                                                                  
and reasonable  drug alternatives.  The change moved  from the                                                                  
legislature  prescribing   rules  to  allowing  the  board  to                                                                  
adopt  their own  regulations that  were  consistent with  CDC                                                                  
guidelines.  The  bill proposed  to  provide nine  months  for                                                                  
the boards to adopt regulations.                                                                                                
Co-Chair   Seaton   MOVED   to   ADOPT    proposed   committee                                                                  
substitute  for SSHB  268,  Work Draft  30-LS1081\E  (Radford,                                                                  
There being NO OBJECTION, it was so ordered.                                                                                    
Representative  Gara began  the PowerPoint  presentation:  "HB                                                                  
268  - Opioid  Prescription Warnings."  He  referenced HB  159                                                                  
[legislation  pertaining   to  the  prescription   of  opioids                                                                  
passed  in  2017],  a bill  sponsored  by  the  governor.  The                                                                  
legislature  since had learned  about the addictive  nature of                                                                  
opioids, that  80 percent of those  using heroin started  on a                                                                  
pain-killing  drug,  and that  the  longer  a person  used  an                                                                  
opioid  the  more  likely  one  was  to  become  addicted.  He                                                                  
relayed that  the death rate  from prescribed opioid  overdose                                                                  
in  Alaska was  about  twice  the national  level.  There  was                                                                  
still  a gap  between  prescribers  either being  informed  or                                                                  
informing  their  patients  of  the  dangers  of  opioids.  He                                                                  
shared that a number of states were adopting similar bills.                                                                     
3:05:00 PM                                                                                                                    
Representative   Gara  moved  to  slide  2:  "The   Nationwide                                                                  
Opioid  Epidemic." Representative  Gara  continued  discussing                                                                  
the bill.  He detailed  that roughly  91 people  died per  day                                                                  
from opioid overdoses.                                                                                                          
Representative   Gara  scrolled  to  slide  3:   "The  Alaskan                                                                  
Opioid Epidemic."  He reported  that heroin-associated  deaths                                                                  
in Alaska  were 50 percent higher  than the national  average,                                                                  
and  there was  a link  between  opioid addiction  and  heroin                                                                  
Representative  Gara moved  to slide 4:  "Extended Opioid  Use                                                                  
Raises  Risk of  Addiction."  The chart  on  the slide  showed                                                                  
that the  longer a person was  on an opioid prescription,  the                                                                  
more likely they would become addicted.                                                                                         
Representative  Gara  advanced   to  slide  5:  "Link  Between                                                                  
Opioid  Abuse   and  Heroin  Addiction."  He   specified  that                                                                  
roughly  80  percent  of  those  using   heroine  started  out                                                                  
misusing prescription opioids such as hydrocodone.                                                                              
Representative Gara turned to slide 6: "HB 268":                                                                                
     Is a patient information bill which seeks to provide                                                                       
     new regulations for prescribing:                                                                                           
Representative  Gara  reported  that the  bill  was a  patient                                                                  
information  bill.   He  considered  that  if   patients  were                                                                  
informed  about   the  dangers  and  addictive   qualities  of                                                                  
opioids,  it  would   be  possible  to  find   less  dangerous                                                                  
alternative treatments.                                                                                                         
Representative  Gara discussed the  language from the  bill on                                                                  
slide 7: "HB 268 con't":                                                                                                        
     Requires  the  state  Board   of  Dental  examiners,  the                                                                  
     State  Medical  Board,  the  Board of  Nursing,  and  the                                                                  
     Board    of    Examiners    in   Optometry    to    adopt                                                                  
Representative   Gara   advanced   to   slide   8:   "HB   268                                                                  
     Requiring prescribers to:                                                                                                  
     "Advise  patients, using  oral  and written  information,                                                                  
     before  prescribing an opioid,  of the potential  dangers                                                                  
     of  opioid  addiction,  and alternatives  to  the  opioid                                                                  
     prescription the provider considers reasonable"                                                                            
Representative   Gara  qualified  that  the  bill   would  not                                                                  
interfere   with  the   provider-patient   relationship.   The                                                                  
intent  was to make  the bill  as simple  as possible so  that                                                                  
it was  useful for providers.  The bill  aimed to give  boards                                                                  
leeway   to   make  exceptions   to   the   requirement.   The                                                                  
requirement   would  generally   apply  to  outpatients,   and                                                                  
providers  could  exempt  classes of  patients.  He  discussed                                                                  
prescriptions  of opioids  for cancer  patients and  suggested                                                                  
some  thought  that cancer  patients  did  not need  the  same                                                                  
information  on the  dangers of  opioids. He  thought a  board                                                                  
might determine  that it was not  sensible to have  to provide                                                                  
information  in  certain  circumstances  such as  for  Hospice                                                                  
care  patients.  He discussed  extenuating  circumstances  and                                                                  
asserted that boards should have leeway.                                                                                        
Representative    Gara   discussed    slide    9:   "HB    268                                                                  
     The boards may:                                                                                                            
     "Determine  which classes of  patients may be  reasonably                                                                  
     exempted   from  the  information  requirement   and  may                                                                  
     allow  an exemption from  the requirement for  violations                                                                  
     the  board   considers  to  be  unintentional,   periodic                                                                  
     accidental  violations,  and  for good  cause,  including                                                                  
     when  a  licensee  needs  to  attend   to  the  perceived                                                                  
     immediate health care of another patient."                                                                                 
Representative Gara scrolled to slide 10: "HB 268 DHSS":                                                                        
     HB 268  also requires that  the Department of  Health and                                                                  
     Social Services                                                                                                            
     "Post   on  the   department's   Internet  website,   and                                                                  
     provide  access  to a  printable  version  of, a  written                                                                  
     statement,  which  may include  graphics,  that  provides                                                                  
     easily    understandable    information    on    opioids,                                                                  
     including   the   potentially   addictive   and   harmful                                                                  
     qualities of opioids."                                                                                                     
     This  written   statement  will  assist   prescribers  in                                                                  
     complying   with  the  patient  information   regulations                                                                  
     adopted by the state boards under this bill                                                                                
3:09:30 PM                                                                                                                    
Representative   Gara  reviewed  slide  11:  "Making   HB  268                                                                  
Effective Without Hurting Doctor-Patient Relationship":                                                                         
     No civil liability for violating bill requirements                                                                         
     Prescribers given broad leeway to make honest mistakes                                                                     
Representative  Gara expressed that  he did not want  there to                                                                  
be  interference in  the  doctor-patient  relationship by  the                                                                  
threat  of lawsuits.  He  reiterated that  the  intent was  to                                                                  
give  boards the  ability to  allow practitioners  the  leeway                                                                  
to make honest mistakes.                                                                                                        
Representative   Gara   explained  how   the   idea  for   the                                                                  
legislation  was brought to  his attention  on slide  12: "CDC                                                                  
Checklist  for   Prescribing  Opioids:  Bill   Implements  CDC                                                                  
Opioid Crisis Voluntary Recommendations":                                                                                       
     Bill    Implements    CDC   Opioid    Crisis    Voluntary                                                                  
     The CDC  recommends that  prescribers discuss the  risks,                                                                  
     benefits,  and  alternatives  to opioid  medication  with                                                                  
     their patients when they prescribe ... and much more.                                                                      
Representative   Gara  thought   that   many  providers   were                                                                  
providing the opioid information, but many were not.                                                                            
Representative  Gara  showed  slide  13:  "CDC  Checklist  for                                                                  
Prescribing  Opioids: Checklist  for  prescribing opioids  for                                                                  
chronic  pain." He  noted that  the CDC  guidelines were  much                                                                  
more comprehensive  than what  was proposed  in the bill;  and                                                                  
boards could adopt more if desired.                                                                                             
Representative   Gara  reported  on  slide  14:   "Why  Inform                                                                  
Patients?" He read the bubbles from the slide:                                                                                  
     We  know of  no other  medication  routinely  used for  a                                                                  
     nonfatal condition that kills patients so frequently?"                                                                     
     Only  about  5  percent  of  patients   being  prescribed                                                                  
     opioid  painkillers   are  receiving  them   for  chronic                                                                  
     pain.  But that small  group accounts  for nearly  three-                                                                  
     quarters of opioid prescriptions. 1                                                                                        
     More  than 70  percent  of patients  who  die of  opioid-                                                                  
     related  overdoses became  addicted  while being  treated                                                                  
     for chronic pain. 1                                                                                                        
     The  CDC  found  that  "many  patients  lack  information                                                                  
     about   opioids  and   identified   concerns  that   some                                                                  
     clinicians    miss    opportunities     to    effectively                                                                  
     communicate about safety."                                                                                                 
          1.The Washington Post, CDC Warns Doctors About                                                                        
          the Dangers of Prescribing Opioid Painkillers,                                                                        
          (March 15 2016)                                                                                                       
          2.Dowell  D,  Haegerich TM,  Chou  R. CDC  Guideline                                                                  
          for  Prescribing Opioids  for Chronic Pain    United                                                                  
          States,  2016. MMWR  RecommRep 2016;65(No.  RR-1):1                                                                   
          49. DOI:  http://dx.doi.org/10.15585/mmwr.rr6501e1                                                                    
Representative    Gara   lamented    that   expanded    opioid                                                                  
information  was  not  being communicated   to patients  in  a                                                                  
uniform way.  The bill  proposed to  require providers  to get                                                                  
training   to   understand   the  dangers   of   opioids   and                                                                  
Representative Gara looked at slide 15: "CDC Guidelines":                                                                       
     This   first  national   guidance  on   the  subject   is                                                                  
     nonbinding,  and doctors cannot  be punished for  failing                                                                  
     to comply.                                                                                                                 
     ...the  head  of  the Centers  for  Disease  Control  and                                                                  
     Prevention,   which  issued  the  guidelines,   said  the                                                                  
     effort  was critical to bringing  about "a culture  shift                                                                  
     for patients and doctors."                                                                                                 
     "Starting   a   patient  on   opiates   is  a   momentous                                                                  
     decision,  and  it should  only be  done  if the  patient                                                                  
     and   doctor   have   a   full   understanding   of   the                                                                  
     substantial risks involved."                                                                                               
     --CDC Director Tom Frieden                                                                                                 
     Source:  The Washington  Post,  CDC  Warns Doctors  About                                                                  
     the  Dangers of  Prescribing Opioid  Painkillers,  (March                                                                  
     15 2016)                                                                                                                   
Representative   Gara  stated   that  while   there  was   not                                                                  
conclusive  proof,  it was  known that  not  all doctors  were                                                                  
providing the  opioid information,  and therefore the  CDC had                                                                  
issued the guidelines.                                                                                                          
3:13:13 PM                                                                                                                    
Representative  Gara advanced to  slide 16: "Recognition  that                                                                  
Prescribers  Don't Always  Inform Patients  about the  Dangers                                                                  
of Opioids." He read a portion of the slide:                                                                                    
     This  problem of overprescribing  opioidsand,   according                                                                  
     to  other research,  failing to warn  patients about  the                                                                  
     risks   of  dependence  and   overdoseisn't   unique   to                                                                  
     emergency  doctors.  Physicians   in  other  specialties,                                                                  
     like  internal  medicine   and  primary  care,  prescribe                                                                  
     even  more  opioids,  Barnett says.  "The  whole  medical                                                                  
     community has a responsibility for this."                                                                                  
     --TIME  Health,  How  Doctors   Are  Fueling  the  Opioid                                                                  
     Epidemic (Feb 17, 2017)                                                                                                    
Representative  Gara relayed  that other  states had  followed                                                                  
the  same approach  as  proposed  in the  bill.  It was  found                                                                  
that emergency  room doctors understood  the need  for greater                                                                  
information  as they  witnessed  the ill  effects of  opioids.                                                                  
He referenced  similar legislation  in the states  of Michigan                                                                  
and  Maine.  He felt  that  the medical  community  was  still                                                                  
catching up to the body of information about opioids.                                                                           
Representative  Gara  wanted to  go through  the  presentation                                                                  
quickly,  and to  provide  additional information.  There  had                                                                  
been  progress   with   the  bill.  The   Dental  Society   (a                                                                  
prescribing  authority) had testified  as to the necessity  of                                                                  
the bill.  Optometrists had a  board and had not  communicated                                                                  
a position  on the bill.  Nurse practitioners  had a  board. A                                                                  
board   covering   doctors  and   osteopaths   had   initially                                                                  
objected  to the  bill  and had  referenced  informed  consent                                                                  
from  patients  for  any  treatment  from  a  physician.  Most                                                                  
recently  the   board  for  physicians  had  advised   it  was                                                                  
considering  regulations to  comply with  CDC guidelines.  The                                                                  
regulations   of   doctors   would    not   govern   dentists,                                                                  
optometrists,  and  advanced nurse  practitioners;  who  would                                                                  
be  governed  by  the  bill.  He  considered   that  when  the                                                                  
physicians  and osteopaths  came onboard  it would solve  over                                                                  
90 percent of the problem.                                                                                                      
Representative  Gara thought  the bill  was a  matter of  life                                                                  
and death.  He stated that the  bill had addressed  the opioid                                                                  
issue  in as  non-intrusive  a  way  as possible  for  medical                                                                  
practitioners  by giving  them help  and  leeway to  formulate                                                                  
exceptions  to  the  rules.  He  made  himself  available  for                                                                  
Co-Chair  Foster  relayed  the  available  testifiers  on  the                                                                  
3:17:34 PM                                                                                                                    
Co-Chair  Seaton  referred  to slide  4  and asked  about  the                                                                  
probability  of  using  opioids  for  one  year  versus  three                                                                  
years. He  wondered if it  meant that  only half as  many were                                                                  
continuing to use.                                                                                                              
Representative  Gara  responded  that the  1-year  probability                                                                  
was  maintaining  and  overusing  opioids  for one  year.  The                                                                  
number  of  people  that  used  for 3  years  was  smaller.  A                                                                  
number  of people  that used  for  one year  did not  continue                                                                  
for  three years.  The  information was  provided  by the  CDC                                                                  
and was in the governor's packet from 2016.                                                                                     
Representative  Wilson asked whether  each board had  a chance                                                                  
to look at the bill and determine the outcomes.                                                                                 
Representative  Gara  responded  that  the Medical  Board  had                                                                  
originally opposed  the bill but  was now coming  onboard with                                                                  
the  legislation.  He  had  no  other   information  from  the                                                                  
Department  of Commerce,  Community  and Economic  Development                                                                  
(DCCED) that other boards had adopted the regulations.                                                                          
Representative  Wilson asked if  the boards had the  chance to                                                                  
discuss the  legislation.  She wondered if  the bill  had been                                                                  
on any of their agendas, so it could be a full discussion.                                                                      
Representative  Gara responded that  he had communicated  with                                                                  
boards through  DCCED and had only  heard a response  from the                                                                  
Medical Board.  He stated there  were some practitioners  that                                                                  
were supportive,  and some that  were not. For those  who were                                                                  
already providing  the information  would not be impacted.  He                                                                  
thought boards  should be  aware of the  bill, which  was pre-                                                                  
filed. The  current version  of the bill  was more relaxed  in                                                                  
terms of adoption of regulations.                                                                                               
3:21:30 PM                                                                                                                    
Representative  Wilson asked  how the bill  would be  policed.                                                                  
She  looked  at page  3  of the  "E"  draft  of the  bill  and                                                                  
wondered  how   classes  of   patients  would  be   reasonably                                                                  
exempted. She asked about the term "good cause."                                                                                
Representative   Gara  responded  that  "good   cause"  was  a                                                                  
commonly  understood  term, and  a board  could  come up  with                                                                  
additional  exemptions  that  it  determined   reasonable.  He                                                                  
used  hospice   patients  and   certain  cancer  patients   as                                                                  
reasonable  examples of  exemptions  that would  be under  the                                                                  
purview of  boards. He reiterated  the desire to leave  boards                                                                  
with  leeway  to  make  exceptions   and  interfere  with  the                                                                  
patient-provider  relationship   as  little  as  possible.  He                                                                  
stated that  the term  "reasonable" was  also well defined  in                                                                  
Representative    Wilson   asked    about   quantifying    the                                                                  
percentage  of   providers  that  did  not  provide   expanded                                                                  
opioid information.                                                                                                             
Representative  Gara  argued that  any providers  not  sharing                                                                  
the  information  were too  many.  The  CDC had  decided  that                                                                  
enough  providers  were  not  providing  information  that  it                                                                  
necessitated  the  adoption  of  national  guidelines,  and  a                                                                  
number  of  states  had  addressed   the  issue  as  well.  He                                                                  
relayed  that the head  of the  CDC had been  very clear  that                                                                  
the evidence  showed providers were  not routinely  giving out                                                                  
the information.                                                                                                                
Representative  Wilson asked  if the  invited testifiers  were                                                                  
Co-Chair   Foster  indicated   that   none   of  the   invited                                                                  
testifiers were not online.                                                                                                     
Representative  Gara argued that  the bill was a  policy call.                                                                  
He continued  that  a number  of practitioners  had  contacted                                                                  
his  office  with  support  as  well  as  opposition.  He  was                                                                  
willing  to listen  to other  medical board  input and  stated                                                                  
that  the Medical  Board  had already  impacted  the bill.  He                                                                  
was not  interested in  a response that  included not  wanting                                                                  
to  be regulated.  He  emphasized  the  need to  mitigate  the                                                                  
deaths from opioid abuse and addiction.                                                                                         
3:26:41 PM                                                                                                                    
Representative  Wilson  agreed  that  the bill  was  a  policy                                                                  
call. However,  she thought  an invitation  to testify  should                                                                  
be extended  for boards. She questioned  how to make  a policy                                                                  
call without input from medical boards.                                                                                         
Co-Chair  Foster conveyed  the names  of  others available  to                                                                  
testify on the bill.                                                                                                            
Representative  Gara responded that  he had sat down  with the                                                                  
deputy  director at  DCCED  that worked  with  boards. He  had                                                                  
authored letters  requesting boards  to comment and  hoped for                                                                  
a response  by the time the bill  moved to the other  body. He                                                                  
hoped the  bill would not get  held in committee.  He believed                                                                  
that  having  proactive  legislation  such  as HB  268,  would                                                                  
result in  boards examining  the CDC  guidelines and  deciding                                                                  
to make them mandatory.                                                                                                         
Representative  Wilson  did  not  want  to hold  the  bill  in                                                                  
committee.  She wanted  to  understand what  boards  currently                                                                  
required.  She did  not want  to duplicate  efforts that  were                                                                  
already in place.                                                                                                               
3:29:17 PM                                                                                                                    
Co-Chair  Seaton referred  to slide  11  of the  presentation.                                                                  
He  asked  about  the provision  of  no  civil  liability  for                                                                  
violation  of bill  requirements  and wondered  if it  applied                                                                  
to providers or boards.                                                                                                         
Representative  Gara  informed  that  the former  bill  was  a                                                                  
requirement  enforced  in  statute. The  current  bill  simply                                                                  
asked  boards  to adopt  regulations,  and  the  boards  would                                                                  
decide  on punishment  and the  adoption of  rules. There  was                                                                  
no civil liability attached to the bill.                                                                                        
Co-Chair  Seaton wanted  to  make sure  that  the terms  would                                                                  
not prevent  the boards  from having  sanctions on  providers.                                                                  
He  discussed  statistics  associated  with  Medicare  Part  B                                                                  
prescriptions.  There  were large  areas  of the  state  where                                                                  
9.5  percent  of  all  prescriptions   for  seniors  were  for                                                                  
opioids; which  was more than  twice the national  average. He                                                                  
was very  concerned  that the  problem was  much greater  than                                                                  
was known.  He agreed with  the bill.  He thought it  was much                                                                  
better for boards to be more involved in the process.                                                                           
3:33:19 PM                                                                                                                    
Representative  Guttenberg had no  doubt that therapeutic  and                                                                  
behavioral  health  providers  recognized  that  there  was  a                                                                  
huge  opioid epidemic.  He did  not believe  that the  medical                                                                  
community  thought it was  their problem.  He asked where  the                                                                  
doctors   considered   the   problem   came   from,   when   a                                                                  
significant  part of  the problem  came  from prescribing  and                                                                  
over-prescribing.  He asked if  doctors understood  their role                                                                  
in the matter.                                                                                                                  
Representative  Gara  thought  many  doctors  and  prescribers                                                                  
had a  good idea of  the problem. However,  he thought  it was                                                                  
true  for  every profession  that  some  people  did  stronger                                                                  
work  than others.  He was  impressed with  an emergency  room                                                                  
physician  from Mat-Su  that understood  the  problem and  had                                                                  
recommended  passing a bill with  a sunset. He chose  to leave                                                                  
the  regulation  to  the boards  instead.  He  referenced  the                                                                  
opioid  addiction training  required  by HB 159,  which had  a                                                                  
deadline in the following two months.                                                                                           
3:37:02 PM                                                                                                                    
Representative  Guttenberg was  concerned  with the fact  that                                                                  
the  boards had  not  come up  with a  policy  to address  the                                                                  
Co-Chair Foster OPENED Public Testimony.                                                                                        
Co-Chair Foster CLOSED Public Testimony.                                                                                        
Co-Chair  Seaton was  confused regarding  the effective  dates                                                                  
of  the bill.  He referred  to  page 7  of the  bill. He  read                                                                  
from  Section 7  and Section  8. He  asked if  there was  some                                                                  
contradiction  in the language.  He wondered if the  dates for                                                                  
implementing  regulation  was a  long enough  time period.  He                                                                  
thought  it  was  important  to  raise  the  question  earlier                                                                  
rather than later.                                                                                                              
Representative  Gara stated  he would  provide greater  detail                                                                  
at  the  next  hearing  of  the  bill.  He  offered  that  the                                                                  
department  could put  the  information  up on  a website  for                                                                  
doctors to  access. He wanted the  bill to provide  boards the                                                                  
time  to give  public  notice  and perhaps  retract  and  redo                                                                  
regulations.  The regulations  would not have  to be  in place                                                                  
until February 1, 2019.                                                                                                         
Co-Chair  Foster   indicated  that  amendments   were  due  on                                                                  
Wednesday, April 4th at 5:00pm.                                                                                                 
HB  268   was  HEARD  and  HELD   in  committee  for   further                                                                  

Document Name Date/Time Subjects
HB0221 Additional Document ACPE Short Q&A 03.23.2018.pdf HFIN 4/2/2018 1:30:00 PM
HB 221
HB0221 Additional Document ACPE Wage Data Bullet Points 03.23.2018.pdf HFIN 4/2/2018 1:30:00 PM
HB 221
HB0221 Sectional Analysis ver A 3.23.18.pdf HFIN 4/2/2018 1:30:00 PM
HB 221
HB0221 Additional Document SLDS_infographic 03.23.2018.pdf HFIN 4/2/2018 1:30:00 PM
HB 221
HB0221 Sponsor Statement 3.23.18.pdf HFIN 4/2/2018 1:30:00 PM
HB 221
HB0221 Supporting Document ACPE Letter 3.23.2018.pdf HFIN 4/2/2018 1:30:00 PM
HB 221
HB0221 Supporting Document NACTEC Testimony 3.23.2018.pdf HFIN 4/2/2018 1:30:00 PM
HB 221
HB400 Sectional Analysis 3.20.18.pdf HFIN 4/2/2018 1:30:00 PM
HB 400
HB400 Sponsor Statement 3.20.18.pdf HFIN 4/2/2018 1:30:00 PM
HB 400
HB400 Supporting Document- DPS Letter of Support 3.20.18.pdf HFIN 4/2/2018 1:30:00 PM
HB 400
HB 268 PP HFIN 4.2.18.pdf HFIN 4/2/2018 1:30:00 PM
HB 268
HB268 Draft Proposed Blank CS ver E 4.2.18.pdf HFIN 4/2/2018 1:30:00 PM
HB 268
HB 221 APS Outcomes Report.pdf HFIN 4/2/2018 1:30:00 PM
HB 221
HB 268 CS vE Explanation of Changes (N-E).pdf HFIN 4/2/2018 1:30:00 PM
HB 268
HB 268 Support ALPHA Owen.pdf HFIN 4/2/2018 1:30:00 PM
HB 268